Skip to main content
Journal cover image

Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study.

Publication ,  Conference
Nowak, RM; Christenson, RH; Jacobsen, G; McCord, J; Apple, FS; Singer, AJ; Limkakeng, A; Peacock, WF; deFilippi, CR
Published in: Ann Emerg Med
July 2020

STUDY OBJECTIVE: We determine the accuracy of high-sensitivity cardiac troponin I (hs-cTnI), European-derived, rapid, acute myocardial infarction, rule-out/rule-in algorithms applied to a US emergency department (ED) population. METHODS: Adults presenting to the ED with suspected acute myocardial infarction were included. Plasma samples collected at baseline and between 40 and 90 minutes and 2 and 3 hours later were analyzed in core laboratories using the Siemens Healthineers hs-cTnI assays. Acute myocardial infarction diagnosis was independently adjudicated. The sensitivity, specificity, and negative and positive predictive values for rapid acute myocardial infarction rule-out/rule-in using European algorithms and 30-day outcomes are reported. RESULTS: From 29 US medical centers, 2,113 subjects had complete data for the 0/1-hour algorithm analyses. With the Siemens Atellica Immunoassay hs-cTnI values, 1,065 patients (50.4%) were ruled out, with a negative predictive value of 99.7% and sensitivity of 98.7% (95% confidence interval 99.2% to 99.9% and 96.3% to 99.6%, respectively), whereas 265 patients (12.6%) were ruled in, having a positive predictive value of 69.4% and specificity of 95.7% (95% confidence interval 63.6% to 74.7% and 94.7% to 96.5%, respectively). The remaining 783 patients (37.1%) were classified as having continued evaluations, with an acute myocardial infarction incidence of 5.6% (95% confidence interval 4.2% to 7.5%). The overall 30-day risk of death or postdischarge acute myocardial infarction was very low in the ruled-out patients but was incrementally increased in the other groups (rule-out 0.2%; continued evaluations 2.1%; rule-in 4.8%). Equivalent results were observed in the 0/2- to 3-hour analyses and when both algorithms were applied to the hs-cTnI ADVIA Centaur measurements. CONCLUSION: The European rapid rule-out/rule-in acute myocardial infarction algorithm hs-cTnI cut points can be harmonized with a demographically and risk-factor diverse US ED population.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

July 2020

Volume

76

Issue

1

Start / End Page

1 / 13

Location

United States

Related Subject Headings

  • United States
  • Troponin I
  • Time Factors
  • Sensitivity and Specificity
  • Prospective Studies
  • Predictive Value of Tests
  • Patient Discharge
  • Myocardial Infarction
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Nowak, R. M., Christenson, R. H., Jacobsen, G., McCord, J., Apple, F. S., Singer, A. J., … deFilippi, C. R. (2020). Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study. In Ann Emerg Med (Vol. 76, pp. 1–13). United States. https://doi.org/10.1016/j.annemergmed.2019.12.008
Nowak, Richard M., Robert H. Christenson, Gordon Jacobsen, James McCord, Fred S. Apple, Adam J. Singer, Alexander Limkakeng, William F. Peacock, and Christopher R. deFilippi. “Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study.” In Ann Emerg Med, 76:1–13, 2020. https://doi.org/10.1016/j.annemergmed.2019.12.008.
Nowak, Richard M., et al. “Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study.Ann Emerg Med, vol. 76, no. 1, 2020, pp. 1–13. Pubmed, doi:10.1016/j.annemergmed.2019.12.008.
Nowak RM, Christenson RH, Jacobsen G, McCord J, Apple FS, Singer AJ, Limkakeng A, Peacock WF, deFilippi CR. Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study. Ann Emerg Med. 2020. p. 1–13.
Journal cover image

Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

July 2020

Volume

76

Issue

1

Start / End Page

1 / 13

Location

United States

Related Subject Headings

  • United States
  • Troponin I
  • Time Factors
  • Sensitivity and Specificity
  • Prospective Studies
  • Predictive Value of Tests
  • Patient Discharge
  • Myocardial Infarction
  • Middle Aged
  • Male